| NPI | 1942436308 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: CA 30928) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: CO CHR-6222) |
| Enumeration Date | 2009-05-29 |
| Last Update Date | 2009-05-29 |